10.31.2010

AIDS Situation in ThailandThailand is a unique case in the study of AIDS, especially in Asia. Although Thailand has the highest prevalence rate in Asia at nearly 1.5%, it is still relatively low when compared to the last two countries I highlighted (Swaziland and South Africa). In Thailand, 80% of HIV infections occur through heterosexual sex and only 20% occur from unprotected high-risk sex between men. The Thai government has done a good job at implementing AIDS programs and awareness campaigns from the beginning of epidemic in the nation in 1984. As a result of the proactive campaigns, the prevalence rate has dropped from 2% in 1993 to the current 1.5% today.

Sex, Drugs, and AIDSSex Workers Although sex work is illegal in Thailand, there are still thousands of commercial sex establishments (such as brothels, massage parlors, and karaoke bars) across the country that are home to youth and adults (some against their will). In the early stages of AIDS in Thailand, sex workers were thought to be especially at risk because of their high-risk sexual encounters as well as their contact with foreigners since AIDS was considered a 'foreign' disease. In the first years of the epidemic, one government official expressed his belief that AIDS was a strictly foriegn disease when he state,

According to the World Health Organization (WHO), prevalence rates among commercial sex workers have significantly decreased since AIDS first was discovered in Thailand. A WHO report showed that in urban areas, the prevalence rate began around 9% in 1990, jumped to nearly 18% in 1992, and has dropped since then to around 4.3%. In non-urban areas of the country, the prevalence rate was much higher in the early stages of the disease - hovering between 15% and 20% from 1992 to 1997 and eventually dropping to around 3.9% today.

WHO chart depicting increase usage
of condoms and a decrease in STIs
in sex worker population

In an effort to reduce the risk in the commercial sex industry in Thailand, the government created a "100% condom campaign" that aims at enforcing condom use in the sex industry by handing out free condoms to the sites and requiring them to be used. If brothels fail to use the condoms then they risk being shut down. This initiative has been shown to be doing great work so far. By forcing brothels to use condoms, they are reducing the risk for not only the sex workers of contracting HIV, but also their clients and their clients' families. It is estimated that without the condom campaign, the HIV prevalence rate in Thailand would be around 10 times higher! Condom usage is up to about 90% in brothels and male conscripts into the army (a group commonly known to visit brothels) have reported that their HIV prevalence has dropped from 4% to 1.5% and that men report visiting brothers less and when they do, they use condoms. I think that Thailand has done a good job at addressing the risk of sex workers and HIV in the country because without the condom campaign, the effects of HIV in Thailand would be similar to those in countries like Swaziland and South Africa where AIDS has wreaked horrible havoc.

Drug-UsersAnother high-risk group in Thailand are injection drug users (IDU). Unfortunately, the statistics for drug users and HIV are not as nice as the ones for sex workers. The World Health Organization found that in 1990, 30% of injection drug users had HIV. That number rose to over 50% in 2002 and has fallen back down to around 40% now. NGOs are implementing harm reduction services and needle exchanges throughout the country in attempts to reduce the risk of HIV in the injection drug community; however, the government has a very hard stance on drug use inside the country which hampers efforts to take control of the HIV situation in the IDU community.

Medicines and PatentsThe Thai government has done an amazing job at making access to antiretroviral drugs (ARVs) extremely easy and cheap for the HIV infected population. Thailand has broken the patents on several big name AIDS medications so that they can provide free drugs to a larger percentage of the population. The government now gives free generic ARVs to anyone that is HIV positive in Thailand and this is applauded by AIDS activists worldwide. However, despite the easy access to treatment, 39% of those in need of medication still lack it as a result of not knowing their HIV status.

Next Stop: ProgressThailand has done a great job at taking control of the AIDS situation despite having the highest prevalence rate in Asia. The Thai government has implemented beneficial programs like the 100% condom campaign and the free ARV initiative that encourage safe sex and proper treatment to those already infected. However, if the situation is to get any better, the government needs to begin addressing the issue of HIV among injection drug users, the one group that remains very much at risk. They also need to address the issue of having more easily available testing for at risk groups so that they can know their HIV status. When people know their HIV status, it is very easy for them to receive the proper medication they need since it is free, but if they don't then they not only get sicker, but they also risk infecting others. Thailand needs to shrink the treatment gap that exists and to lower the prevalence rate among IDUs and if they do that, they will be a shining star in the HIV community.

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Cameroon is called 'Africa in Miniature' due to its diversity of languages, cultures, and geographies. I live in Ngatt (by the big lake), in the Adamawa region - the transitional zone of Cameroon and the first region of the Grand North.

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